10th International Conference on Screening for Lung Cancer
Author: Fred GrannisThe 10th International Conference on Screening for Lung Cancer was held at Weill Medical College of Cornell University in New York City April 23-25, 2004. More than 200 physicians, research scientists, nurses and lung cancer patient advocates from ten nations attended the conference.
In the Lustral Lecture, Claudia Henschke MD PhD, the primary investigator of the International Early Lung Cancer Action Program (I-ELCAP), reported on ongoing experience with low dose, non-contrast, spiral computerized tomograms (CT scans) in more than 26,000 patients at high risk for lung cancer screened by I-ELCAP as part of an prospective, international, multi-institutional study. She reported that more than 379 study subjects have been diagnosed with lung cancer during the. 98% of cancers were screen-detected, which means that only 2% presented clinically in the interval between annual screening exams. This is an important finding, because opponents of lung cancer screening postulate that fast-growing lung cancers will present between screenings in advanced stage. The results of this study suggest that this risk is much lower than anticipated.
81% of lung cancers were detected in Stage I, including a very high percentage discovered in stage 1A. In the U.S. today, less than fifteen percent of lung cancers are discovered in stage I, and only 7% are found in stage IA. Early stage detection is very important. Only 12% of Americans with lung cancer currently survive 5-years following diagnosis and initial treatment of lung cancer, but cure rates in patients diagnosed in stage I are much higher, and more than 80% of patients in stage IA experience long-term survival. Study results also show that women appear to have an increased risk of lung cancer compared to men of the same age and smoking history.
Also on Friday, multiple lecturers recapped recent developments in ongoing lung cancer trials in other countries and on new developments in the science and clinical practice of early detection and treatment of lung cancer. The Nancy Terner Behrman Lecture in Honor of Betty Flehinger PhD was presented by Eugene Petricoin on "Translational applications of clinical proteomics to cancer detection and personalized medicine."
On Saturday April 24, 19 investigators presented original research results in the areas of screening, early diagnosis and innovative treatment of early stage lung cancer. In the afternoon, conference delegates attended three individual breakout I-ELCAP workshop sessions to discuss intervention research, practice guidelines and development of a WWW-based teaching file on lung cancer screening and treatment.
The intervention workshop chaired by Harvey Pass MD, discussed the possibilities of more limited surgical treatment for patients with very small, screen detected lung cancers in a prospective research setting. The importance of prioritizing research into treatment of non-solid nodules and solid lung cancers 1.0 cm. and less in diameter was emphasized. Japanese surgeon investigators attending the session provided an important contribution by sharing their extensive experience with these lesions. A sub-committee will present recommendations for research trials in these areas at the Rome meeting.
At a reception held at the St. Regis Hotel Saturday night, the Medicsight Foundation awarded a grant of $1.8 million to Dr. Henschke and I-ELCAP to provide support of a smoking cessation intervention trial to be performed by I-ELCAP within the context of lung cancer screening. This prospective trial is funded by a challenge grant from the American Legacy Foundation.
On Sunday, April 25, the I-ELCAP workshops reported to the conference. A consensus New York Declaration of the conference states that there is now sufficient evidence to conclude that:
1. Low-dose, non-contrast, spiral CT scanning in the context of the I-ELCAP research protocol detects a very high percentage of lung cancers in stage I.
2. There is strong evidence that treatment of lung cancer in stage I is effective, and results in a high rate of long term survival.
3. Lung cancer staging should be revised based upon new information arising out of new information on new subcategories of lung cancer detected by screening, including cancers presenting as pure non-solid nodules and very small cancers, less than 10-15 mm in diameter.
The 11th and 12th International Conferences on Screening for Lung Cancer will be held in Rome, Italy, October 15-17, 2004 and in Japan April 1-3, 2005.